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PayerView 2016: Payers. Ranked.

by Kim Green, Senior Payer Intelligence Manager

athenahealth’s Payer and Healthcare Outreach team is proud to present the 2016 edition of PayerView, our annual report on the performance of the largest payers in our athenaNet network.  Now in its 11th year, PayerView aims to do three big things:

  1. Provide evidence-based insight on payer performance to help practices respond to industry trends;
  2. Uncover opportunities for payer performance optimization; and
  3. Use the data as a framework to inform initiatives aimed at creating transparency between providers and payers.

A lot has changed since we released our first edition of PayerView way back in 2006.  The Red Sox won another championship. Star Wars is back.  Most importantly: our health care system has undergone a momentous transformation that continues today.  With this ongoing change in mind, we offer PayerView 2016 with a focus on the necessity of collaboration – on health care stakeholders working together to succeed in a changing world.

But first things first: Inquiring minds want to know which payers performed best on our eight key metrics this time around. 

Let’s take a look at the overall Top 10 performers for 2016: 

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The story here is diversity.  A large, national commercial payer, Cigna, earns the #1 spot.  Two smaller commercial payers – Health New England and UniCare – also earn strong marks.  Medicare Part B payers and Blues comprise the remainder of the Top 10.  This diversity gets at one of the big insights that PayerView continues to surface: Different types of payers bring different strengths to the table.  For example:

  • National commercial payers like Cigna perform best on our Enrollment Efficiency metric, a measure of how easy it is for providers to complete a payer’s enrollment processes. 
  • Blues lead the charge on our most important metric, Days in Accounts Receivable (DAR), which is exactly what it sounds like – an indicator of how quickly a payer pays providers. 
  • Medicare Part B payers excel at our First-Pass Resolve Rate (FPR) metric, a gauge of a payer’s ability to resolve a claim after its first submission. Medicare payers publish clear claim requirements allowing athena to build that logic into our network to improve performance.

And how did the set of “major payers” – those with the largest volume across our network – stack up in PayerView 2016?  

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The rankings are exciting to follow, but PayerView is much more than just a score card.  It's also a resource for providers, payers, and the broader healthcare industry to use to inform their work and work better together. 

For payers, PayerView surfaces trends that can point to opportunities for performance improvement.  athena’s Payer and Healthcare Outreach team works directly with some of our biggest payer partners to take advantage of these opportunities by collaborating on metric-specific performance optimization projects.  Through these partnerships, we have a toolkit of initiatives – like strategies for driving down Denial Rate or operational enhancements to increase Enrollment Efficiency – that can improve a payer’s processes and workflows and that we are eager to put to use with any payer in our network!

And for providers, the performance improvements that PayerView can drive are a prime example of athenahealth’s “network effect” in action.  PayerView incents payers to bring their A-game – to aim for a low Days in Accounts Receivable and a high First-Pass Resolve Rate.  That focus on performance benefits all the providers on athenaNet who submit claims to the same payer currently and down the road. That’s a win-win! 

Stay tuned for a follow-up post with our thoughts on how the evolving healthcare marketplace is creating new challenges and opportunities for payers and providers! And in the meantime, check out www.athenahealth.com/PayerView to the see the full PayerView 2016 report!

 

 


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